Non-comorbid Respiratory Factor and Work of Breathing in Pediatric COVID-19 Patient: How is Their Synergistic Correlation with the Level of Care?

Background: Work of breathing (WOB) and non-comorbidities factors in the respiratory system are the two probable findings in pediatric COVID-19 patients. However, the association of those factors with level of care was not well reported. Purpose: This study aimed to identify the relation between potential predictors including comorbidity, low nutritional fulfillment, infectious disease, shock, cough, O2 saturation reduction, abnormal blood gas analysis and sore throat with the level of care among pediatric COVID-19 patients. We also analyzed the synergistic correlation of non-comorbidities factors in the respiratory system and work of breathing to predict level of care in pediatric COVID-19 patients. Methods: A cross-sectional study was conducted in the six referral hospitals from July to September 2020 in four provinces in Indonesia. An observation checklist was used to collect data from the medical records of pediatric patients with COVID-19, including medical diagnosis, demographic, and clinical manifestation. This study included 423 participants aged from 0 to 18. The multivariate logistic regression was performed to test the adjusted odds ratios (AORs) with the 95% confidence intervals (CIs) of the association between WOB, non-comorbid respiratory, and level of care. Moreover, dummy variables (2x2) were made to analyze synergistic correlation of non-comorbid respiratory disease and WOB. The AOR with the 95% CIs was applied in the association between the complication of non-comorbid respiratory diseases and high work of breathing with level of care among pediatric patients with COVID-19. Results: Results showed that age, presence of comorbidity, nutritional fulfillment, infectious disease, shock, work of breathing, O2 saturation reduction, abnormal blood gas analysis, sore throat, and convulsive meningeal consciousness were significantly associated with the level of care (p<0.05). Pediatric patients with non-comorbid respiratory and increased work of breathing had a 15.59 times higher risk of requiring PICU care level (p<0.01). Meanwhile, pediatric patients who experienced both non-comorbid respiratory and increased work of breathing had a 5.76 times risk of requiring an intermediate level of care (p<0.05), and 9.32 times higher risk of requiring a PICU level of care (p<.05). Conclusion: It was found that both non-comorbid respiratory and increased WOB had a significant relationship with the level of care for pediatric patients with COVID-19. Nurse should take into account those clinical findings to increase the awareness in monitoring clinical deterioration in pediatric COVID-19 patients. © 2022 Nurse Media Journal of Nursing. All rights reserved.

Repercussion of the Covid-19 Pandemic on Access to Health Services at the First Level of Care in a Region of Peru

The objective of the article was to determine the impact of the covid-19 pandemic on access to health services at the first level of care in the Huancavelica region 2020. A basic, explanatory, non-experimental and cross-sectional investigation was carried out. The population consisted of 330,168 (2020) and 301,390 (2019) affiliated with the Comprehensive Health Insurance (SIS), the documentary analysis technique was used, the analysis of variables was carried out using the Pearson correlation coefficient, coefficient of determination and linear regression. The results show that in times of the covid-19 pandemic there was a 24% decrease in access to health services, significance p = 0.000 (p < 0.01), r = 0.98 and r2 = 0.98. The covid-19 pandemic had a negative impact on access to health services at the first level of care in the Huancavelica region.

Comparison of the clinical characteristics and outcomes of Japanese patients with COVID-19 treated in primary, secondary, and tertiary care facilities.

AIM: To compare the characteristics and clinical course of patients with coronavirus disease (COVID-19) according to the healthcare level of the admitted hospital, to provide an insight into determining the appropriate level of care for each patient. METHODS: This retrospective, observational study utilized data from the COVID-19 Registry Japan (COVIREGI-JP), the largest Japanese registry of hospitalized patients with COVID-19. Datasets were obtained from reports filed as of May 31, 2022. RESULTS: A total of 59,707 patients (2004 in the primary care group, 41,420 in the secondary care group, and 16,283 in the tertiary care group) from 585 facilities were included in the analysis. Patients with established risk factors for severe disease, such as old age and the presence of comorbidities, were treated at higher care facilities and had poorer initial conditions and in-hospital clinical course, as well as higher mortality. Analysis of the fatality rates for each complication suggested that patients with complications requiring procedures (e.g. pleural effusions, myocardial ischemia, and arrhythmia) may have better survival rates in facilities with specialist availability. The number of deaths and severe COVID-19 cases in this study were notably less than those reported overseas. CONCLUSION: Our results showed that more difficult COVID-19 cases with poor outcomes were treated at higher care level facilities in Japan. Attending to possible complications may be useful for selecting an appropriate treatment hospital. Healthcare providers need to maintain a broad perspective on the distribution of medical resources.

Airway management, intensive care requirement, and corticosteroid use in cervicofacial infection. A Maxillofacial Trainee Research Collaborative (MTReC) study.

Cervicofacial infection (CFI) is a frequently encountered presentation to Oral and Maxillofacial Departments (OMFS). The United Kingdom has recently seen cessation of all routine community dental treatment due to the Coronavirus (COVID-19) pandemic and consequently an initial modification of treatment received in secondary care. Subsequent airway difficulties and the need for level 2 High Dependency Unit (HDU) or level 3 Intensive Care Unit (ICU) is a concern to surgeons and anaesthetists alike. The availability of skilled staff and appropriate facilities can be variable. It is imperative to understand the resource implications of CFI with respect to airway management and critical care utilisation. Adequate provision is fundamental for optimal care. A national, multicentre, trainee-led audit was carried out across 17 hospitals in the UK from May to September 2017. Information recorded included demographic features, presentation, airway management, medical and surgical treatment, and steroid administration. One thousand and two presentations (1002) were recorded. Forty-five percent were female, with a mean (range) age of 37.5 years (0-94). Regarding surgical airway management, 63.4% had a standard intubation (oral 42%, nasal 21.4%). Awake fibreoptic intubation (AFOI) was performed in 28% and surgical airway required in 0.9%. Impending airway compromise at the time of presentation was 1.7%. Following surgical incision and drainage, 96.1% of patients returned to a general ward, 2.7% to Level 3, and 1.1% to Level 2 care. The return to theatre was 2.8%, and 0.7% required reintubation. There was an association between corticosteroid administration and duration of intubation. Those who received steroids were more likely to remain intubated postoperatively (p = 0.006), require a higher level of postoperative care (p < 0.001), and require a return to theatre (p = 0.019). Postoperatively, patients who received steroids were less likely to be extubated at the close of the procedure. Intubated patients who received multiple steroid doses postoperatively were extubated with less frequency those that received a single dose. To our knowledge, this dataset is the largest ever recorded for CFI. Our results showed a high requirement for advanced airway management in this cohort. The requirement for surgical airway was low, but the significance of this situation should not be underestimated. The relatively frequent need for care at levels 2 or 3 within this cohort also placed a significant demand on already overburdened resources. Knowledge of care requirements for these patients will inform resource planning.

Family caregiver quality of life and the care provided to older people living with dementia: qualitative analyses of caregiver interviews.

BACKGROUND: While studies have examined the quality of life (QoL) of family caregivers for people living with dementia, it is not yet clear how these caregivers' quality of life affects their ability to meet the care demands of their loved ones. The purpose of the study was to explore caregivers' perceived quality of life in relation with the care provided to persons with dementia. METHODS: Twenty-three caregivers participated in this study. These caregivers participated in focus groups or one-on-one interviews after completing questionnaires regarding their own quality of life as well as the care provided to their loved ones with dementia. The interview and focus group transcripts were analyzed using qualitative description methodology. RESULTS: Regarding the relationship between caregiver QoL and the care provided to older people with dementia, the following themes were derived: (1) needs of the person with dementia; (2) caregivers' ability to cope with progressing needs of the care recipient; (3) availability and accessibility of support for the caregiver; (4) unmet needs of the caregiver; and (5) ability of the caregiver to meet their own progressing needs as the condition of the care recipient deteriorates. CONCLUSIONS: Findings from this study suggest that caregiver quality of life is important for the care they provide to their loved ones living with dementia. The study highlights the need for the provision of much needed support for caregivers and older people living with dementia. These issues are particularly important during and post-pandemic.

Intensive care unit discharge: mind the gap!

Mortality after intensive care discharge is a hot topic in critical care medicine. Many factors probably play a role: patient's comorbidities and severity of the disease may have great impact on mortality. However it should be taken into account also the level of care that characterizes the ward in which the patient is discharged to. A soft transition from intensive care units to the other hospital wards is desirable to avoid the traumatic step that the fragile post-ICU patient has to face with.

Development and validation of a predictive model to determine the level of care in patients confirmed with COVID-19.

BACKGROUND: The COVID-19 pandemic has imposed significant challenges on hospital capacity. While mitigating unnecessary crowding in hospitals is favourable to reduce viral transmission, it is more important to prevent readmissions with impaired clinical status due to initially inappropriate level of care. A validated predictive tool to assist clinical decisions for patient triage and facilitate remote stratification is of critical importance. METHODS: We conducted a retrospective study in patients with confirmed COVID-19 stratified into two levels of care, namely ambulatory care and hospitalization. Data on socio-demographics, clinical symptoms, and comorbidities were collected during the first (N = 571) and second waves (N = 174) of the pandemic in Belgium (2 March to 6 December 2020). Univariate and multivariate logistic regressions were performed to build and validate the prediction model. RESULTS: Significant predictors of hospitalization were old age (OR = 1.08, 95%CI:1.06-1.10), male gender (OR = 4.41, 95%CI: 2.58-7.52), dyspnoea (OR 6.11, 95%CI: 3.58-10.45), dry cough (OR 2.89, 95%CI: 1.54-5.41), wet cough (OR 4.62, 95%CI: 1.93-11.06), hypertension (OR 2.20, 95%CI: 1.17-4.16) and renal failure (OR 5.39, 95%CI: 1.00-29.00). Rhinorrhea (OR 0.43, 95%CI: 0.24-0.79) and headache (OR 0.36, 95%CI: 0.20-0.65) were negatively associated with hospitalization. A receiver operating characteristic (ROC) curve was constructed and the area under the ROC curve was 0.931 (95% CI: 0.910-0.953) for the prediction model (first wave) and 0.895 (95% CI: 0.833-0.957) for the validated dataset (second wave). CONCLUSION: With a good discriminating power, the prediction model might identify patients who require ambulatory care or hospitalization and support clinical decisions by Emergency Department staff and general practitioners.

From fragmented levels of care to integrated health care: Framework toward improved maternal and newborn health.

Worldwide, health systems and care approaches vary widely due to local reality, distance to facilities, cultural norms, resources, staff availability, geography, and politics. Consequently, globally maternal-newborn dyad care and outcomes are highly variable, leading to approximately 800 maternal deaths daily with a 100-fold difference among high- and low-resource countries. Irrespective of where care is received, maternal safety and wellbeing should be preserved. Despite ongoing efforts, however, this is not the case. Large gaps exist between spending and clinical outcomes. Segmented health care, coupled with poor planning and inadequate resource distribution, results in failure to provide essential life-saving treatment. The proposed solution is a regional integrated care model from midwife to advanced level III/IV care and the newborn unit, achieved through effective coordination by site, staff, and clinicians. This model has been successfully implemented in high- to low-resource countries in the past 20 years. In the large diverse population of the United States, constructive steps have been implemented to reduce high maternal mortality in black and rural communities. The COVID-19 pandemic demonstrates the feasibility of rapid resources coordination to provide effective advanced care. The proposed integration of resources will have a major positive impact on the maternal-newborn dyad.